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  1. João Freitas1,3,
  2. Renato Andrade1,2,4,
  3. Rogério Pereira1,2,4,5,
  4. Ana Leal1,2,6,
  5. Cátia Saavedra1,2,
  6. Nuno Pais7,
  7. Diana Marques1,
  8. Isabel Lopes1,
  9. Nuno Loureiro1,8,9,
  10. Paulo Maia1,3,
  11. Ovídio Costa1,3,
  12. João Espregueira-Mendes1,2,3,10,11,12
  1. 1Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal
  2. 2Dom Henrique Research Centre, Porto, Portugal
  3. 3Faculty of Medicine, University of Porto, Porto, Portugal
  4. 4Faculty of Sports, University of Porto, Porto, Portugal
  5. 5University Fernando Pessoa, Porto, Portugal
  6. 6CMEMS Center for MicroElectroMechanical Systems, Mechanical Engineering Department, University of Minho, Braga, Portugal
  7. 7ULS Nordeste, Macedo De Cavaleiros, Portugal
  8. 8Portuguese Federation of Cycling, Lisboa, Portugal
  9. 9Futebol Clube Paços de Ferreira, Paços de Ferreira, Portugal
  10. 10Orthopaedics Department of Minho University, Braga, Portugal
  11. 113B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Braga/Guimarães, Portugal
  12. 12ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal


Background Sports pre-participation cardiovascular screening remains a challenging topic, without consensus amongst the scientific community. Sports pre-participation cardiovascular screening with electrocardiogram (ECG) is not systematically included in the United States of America. However, in some European countries both ECG and echocardiogram are requested. These asymmetric proceedings are related with the ongoing discussion on health-related benefits effectiveness and costs.

Objective Define the proportion of cardiovascular screening exams which require complementary cardiovascular exams in addition to the routine electrocardiogram performed by the athletes. Moreover, it was intended to analyze the influence of the complementary cardiovascular exams results' in the decision making for medical clearance.

Design Retrospective cohort study.

Setting Nonprofessional to elite athletes.

Patients (or Participants) Between 2014 and 2015, a total of 862 athletes performed sports pre-participation cardiovascular screening.

Interventions (or Assessment of Risk Factors) All the athletes underwent a cardiovascular screening, including medical history, physical examination and 12-lead electrocardiogram. In case of cardiovascular diseases suspicion, complementary cardiovascular exams (echocardiogram and cardiac stress test) were solicited.

Main Outcome Measurements As main outcomes were considered the need for complementary cardiovascular exams according the Seattle criteria (%), presence of abnormalities in these complementary cardiovascular exams (%) and decision for medical clearance (%).

Results From the 862 athletes, 54 (6%) required complementary cardiovascular exams, of which 8 (0.9%) showed abnormal cardiovascular findings. Three athletes (0.3%) did not get medical clearance to participate in sports.

Conclusions The sports pre-participation cardiovascular screening with ECG required complementary cardiovascular exams in 6% of the cases and 0.3% were not cleared to participate in sports. The decision was based in the most up-to-date knowledge of life threatening cardiac clinical conditions and supports a life-preventive measure to 3 young persons over an approximate cost of 12000€.

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